Report Title:

QUEST Enabling Services

Description:

Removes financial disincentives for health plans and providers to actively reach out to high-risk populations. (HB671 HD1)

HOUSE OF REPRESENTATIVES

H.B. NO.

671

TWENTY-SECOND LEGISLATURE, 2003

H.D. 1

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to quest.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that it is in the best interest of the State to ensure access to primary and preventive health care for its residents. In addition to creating a healthier population, access to health care reduces state expenditures arising from hospital and emergency room services for preventable injuries or illnesses.

The legislature further finds that Hawaii's system of nonprofit, community health care providers actively reaches out to many high-risk and high-cost patients who otherwise would not seek out primary medical care.

The services delivered by health centers to assure access to otherwise noncompliant patients are called enabling services.

The purpose of this Act is to remove financial disincentives for health plans and providers to actively reach out to high-risk populations, including high-risk pregnant women and girls, native Hawaiians with early onset of chronic diseases, and chronic substance abusers.

SECTION 2. The QUEST medicaid agency is directed to calculate and withhold from health plan capitalization payments all dollars budgeted for perinatal services, including obstetric and other delivery costs. All withheld funds shall then be pooled and distributed by plans retrospectively on a case rate basis when there is a documented pregnancy within the health plan's population. This carve out shall be effective July 1, 2003.

SECTION 3. The QUEST program shall request state health plans to provide claims-paid data on substance abuse and related behavioral health encounter information for the purpose of assessing the feasibility of a substance abuse carve-out beginning July 1, 2004. This initiative shall focus on providing services for users of methamphetamine and other dangerous drugs in Hawaii.

SECTION 4. The department of human services shall define enabling services, to be provided by QUEST plans, to include all of the following:

(1) All federally qualified health center enabling services covered by medicaid payments prior to initiation of the QUEST program, including those covered under early periodic screening development testing;

(2) Native Hawaiian and traditional healing services when there is documentation in the patient's medical record, entered by the primary care physician, that such services are part of a plan to facilitate comprehensive primary care services and treatment; and

(3) The following federally qualified health center enabling services, as defined in "Medical Group Management Association Center for Research" (September, 2000):

(A) Case management shall include documented client-centered service provided either on-site or off-site that links clients with health care and psychosocial services to ensure timely and coordinated access to appropriate levels of health and support services and continuity of care for improving or maintaining the individual's life management skills, or the ability to function in the community, or both. Key activities in this area include:

(i) Assessment of the client's needs and personal support system;

(ii) Development of a written, comprehensive individualized service plan, including goal development;

(iii) Coordination of services required to implement the plan and client monitoring to access the efficacy of the plan; and

(iv) Periodic re-evaluation and adaptation of the plan as necessary;

(B) Outreach services shall include the location of high-need, resistant services, or home-bound individuals by developing and utilizing active and passive case-finding efforts to engage them in basic services for the purposes of improving their health, mental health, and social functioning, or increasing their service and resource utilization. Types of contact shall include case-finding, education, or other engagement strategies, information referral, and follow-up. Specific examples of this type of service shall include home visits for:

(i) Missed prenatal care visits;

(ii) Newborn assessment and care training; or

(iii) Contacting patients without telephones, including assistance in completing necessary QUEST administrative requirements to remain Med-QUEST eligible;

and

(C) Supportive counseling services shall include counseling sessions for the purpose of providing a supportive environment to discuss a client's concerns. This counseling can be provided on an individual, group, or family basis and may include the use of traditional healers. Specific lifestyle issues, such as homelessness, substance abuse, housing, and similar issues may be addressed in this forum.

SECTION 5. The department of human services shall submit for federal review any changes in the state medicaid plan.

SECTION 6. This Act shall take effect on July 1, 2003.